International audienceSummaryBackground Neuraminidase inhibitors were widely used during the 2009–10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection. Methods We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinically diagnosed pandemic influenza A H1N1pdm09 virus infection. We identified potential data contributors from an earlier systematic review of reported studies addressing the same research question. In our systematic review, eligible studies were done between March 1, 2009 (Mexico), or April 1, 2009 (rest of the world), until the WHO declaration of the end of the pandemic (Aug 10, 2010); however, we continued to receive data up to March 14, 2011, from ongoing studies. We did a meta-analysis of individual participant data to assess the association between neuraminidase inhibitor treatment and mortality (primary outcome), adjusting for both treatment propensity and potential confounders, using generalised linear mixed modelling. We assessed the association with time to treatment using time-dependent Cox regression shared frailty modelling. Findings We included data for 29 234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0·81; 95% CI 0·70–0·93; p=0·0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0·48; 95% CI 0·41–0·56; p<0·0001). Early treatment versus no treatment was also associated with a reduction in mortality (adjusted OR 0·50; 95% CI 0·37–0·67; p<0·0001). These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day's delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset (adjusted hazard ratio [HR 1·23] [95% CI 1·18–1·28]; p<0·0001 for the increasing HR with each day's delay). Interpretation We advocate early instigation of neuraminidase inhibitor treatment in adults admitted to hospital with suspected or proven influenza infection. Funding F Hoffmann-La Roche

Poisoning after eating puffer fish containing highly lethal tetrodotoxin (TTX) is widespread in Asia. In 2008, naïve inland populations in Bangladesh were exposed to cheap puffer fish sold on markets. In three outbreaks, 141 patients with history of puffer fish consumption were hospitalized. Symptoms of poisoning included perioral paraesthesia, tingling over the entire body, nausea and vomiting, dizziness, headache, abdominal pain and muscular paralysis of the limbs. Seventeen patients (12%) died from rapidly developing respiratory arrest. Blood and urine samples from 38 patients were analyzed using a TTX-specific enzyme-linked immunoassay (ELISA). Medium to high TTX levels were detected (1.7-13.7 ng/ml) in the blood of 27 patients. TTX was below detection level (< 1.6 ng/ml) in 11 blood samples but the toxin was detected in urine. Ten patients had blood levels above 9 ng/ml and developed paralysis; seven of these died. The remaining patients recovered with supportive treatment. High concentrations of TTX and its analogues 4-epiTTX and 4,9-anhydroTTX were also found in cooked puffer fish by post-column liquid chromatography-fluorescence detection. To prevent future instances of puffer fish poisoning of this magnitude, measures should be implemented to increase awareness, to control markets and to establish toxicological testing. To improve the management of this and other poisoning in Bangladesh, facilities for life-saving assisted ventilation and related training of healthcare personnel are urgently needed at all levels of the health system.

BackgroundThe impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection.MethodsA worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids.ResultsOf 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)].ConclusionsEarly NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.

PATIENTS AND METHODS Study design.The study was an open-label, single-group trial of miltefosine at 12 outpatient centers in VL-endemic regions of Dhaka, Rajshahi, and Mymensingh, Bangladesh.Patients. Patients were 2-65 years of age. Both male and female patients participated, and patents were enrolled during October 2006-September 2007. Inclusion criteria were signs and symptoms compatible with VL (fever for at least two weeks, palpable splenomegaly, weight loss by history), positive serologic test result for leishmaniasis (rK39), 7 hemoglobin level ≥ 6 g/dL, no infection with HIV, not pregnant or lactating, not being currently treated with an antileishmanial compound, and no significant concomitant medical condition. Malaria and enteric fever were ruled out by blood smears and the Widal test, respectively. If present, malaria and enteric fever were treated. These patients could then be admitted into the study. If tuberculosis was suspected on clinical grounds, the patient was not eligible for this study.Study procedures. Enrolled patients were given sufficient drugs for treatment for one week. Patients returned to the outpatient clinic once a week for three successive weeks for assessment of compliance and adverse events (AEs) and to receive drug for the next week's treatment. At the end of 28 days of treatment, patients were assessed for initial cure and were given instructions for follow-up at two months and six months after the end of treatment.Drug treatment. Miltefosine was administered daily for 28 days after meals. For children (≤ 12 years of age), the daily dose was 2.5 mg/kg body weight using 10-mg capsules split into twice-a-day doses. For adults (> 12 years of age) weighing < 25 kg, the daily dose was 50 mg of miltefosine/day as one capsule (50 mg) in the evening. For adults (> 12 years) weighing ≥ 25 kg, the daily dose was 100 mg of miltefosine as one capsule (50 mg) in the morning and one capsule in the evening.Assessments. Efficacy parameters (temperature and weight, spleen size, and hemoglobin level) were evaluated at initial screening and on days 7, 14, 21 and 28 of treatment and 2 months

From late December’19 till the end of August 2020, in this nine months period, world has lost more than eight hundred thousands people due to COVID-19 pandemic. Clinical data on COVID-19 in Bangladesh is less. The objective of our study was to evaluate demographic and clinical profile with in a defined period among COVID-19 Bangladeshi Patients in a Tertiary Care Private Medical College Hospital of Dhaka. We conducted a retrospective descriptive study on epidemiological & clinical profile along with short term treatment outcomes of 190 COVID-19 patients from COVID dedicated unit of Popular Medical College Hospital (PMCH) during the period of 18th June to 22nd August 2020 (2 months) with a pre-determined case record form (CRF).Among this 190 patients, mean age was found to be 53 years. Highest percentage of patients (44%) belonged to 41-60 years of age. Regarding gender distribution, two-third patients were male (65%) & one-third patients were female (35%). The predominant symptoms of our enrolled patients were fever (88%),cough (81%) , dyspnoea (58%) & fatigue( 50%). Around half of the patients had been suffering from Hypertension (54%) and Diabetes (47%). Almost half of our patients belonged to moderate severity (48%).The duration of Hospital stay was from 1-36 days, mean was 7 days. There was significant difference for severe and non-severe cases (p value 0.01). J MEDICINE JUL 2020; 21 (2) : 82-88

Conclusions: Vitamin D status was associated with a number of socio-demographic variables. Knowledge of these variables may improve targeted education and public health initiatives.

Abstract:Background: In our country, there are many studies on stroke, its associated conditions and their effect on stroke

Introduction :In Bangladesh, the first confirmed case of COVID1 9 was detectedon 8th March’2020, almost 3 months after the initial outbreak in late December’ 2019 in Wuhan, China.The number of affected cases and deaths both have become exponential during this global pandemic. Clinical data on COVID 19 in Bangladesh is still lacking. The objective of our study was to evaluate clinico-demograhic Profile, treatment Outline & clinical outcome within a defined period among COVID-19 Bangladeshi Patients. Methods: We conducted a retrospective multicenter descriptive study on epidemiological & clinical profile along with treatment outcomes of 236 Rt-PCR confirmed patients of COVID 19 from COVID dedicated units of 3 hospitals- Dhaka Medical College Hospital ( DMCH)(n-87), Kuwait Bangladesh Moitry Hospital ( KBMH)(n-50),Popular Medical College Hospital ( PMCH)(n-99) during the period of May to July 2020 with a pre-determined case record form. Results: Among the total 236 patients, highest percentage of patients (26%) belonged to 50-59 years age range, however it was found that no age was immune.Regarding gender distribution, two-third patients were male (65%) & one-third patients were female (35%).The predominant symptoms of our enrolled patients were fever (89%), cough (85%) & dyspnea (76%) ,fatigue (23%), chest pain (23%)& anosmia (19.5%), followed by gastro-intestinal symptoms. Almost half of the patients had been suffering from Hypertension (48%) and Diabetes (47%) Regarding treatment, 100% patients received tromboprophylaxis with low molecular weight Heparin (LMWH)& around 2/3 patients received steroid in different forms following treatment protocol of our national guideline. 20% patients required ICU support & death rate was 4.7%. Around two-third patients could be discharged in < 10 days’ time. Conclusion: Covid-19 in Bangladesh is presented in adult male with fever, cough and dyspnoea predominantly with occasional lack of taste and smell. Supportive care was effective with predominantly good outcome Bangladesh J Medicine July 2020; 31(2) : 52-57